20220034 Ver 1_Shoreline Stabilization_20220105

Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
...................................................................................................................................................................................................................................................................................................................................................................
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Kim Broome
Please provide an email address for payment and requests for more information here.
Robert Stamper
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
13000-F South Tryon St. Suite 303
Address Line 2
City
Charlotte
Postal / Zip Code
28278
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Kim Broome
Dock Masters Marine
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
Mecklenburg

Mailing Address:*
Street Address
5850 Charlotte Hwy
Address Line 2
City
Clover
Postal / Zip Code
29710-7524
A signed and dated copy of the Agent Authorization letter:
stamperagent.pdf 236.41 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Stamper Shoreline
State / Province / Region
SC
Country
US
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and roads.*
Upload File
Look up address
Upload Map: stampermap.pdf
stamperprefill.pdf
Latitude: * 35.093760
423.8KB
369.92KB
Longitude: *-81.043579
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging below
Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the diagram under
section 12.normal pool lake level/normal water level*
stamperplat.pdf 320.59KB
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/Shoreline%2OLayout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)
stamperpicture.pdf 608.52KB
stamperplat.pdf 320.59KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Charlotte
County: * Mecklenburg
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address: * Forest Home Rd Charlotte, NC 28278
Include phase/lot number

Directions to site: *
Hwy 49 turn R- R onto Red Fez club rd. R onto Walnut Hill R onto
Gardenside end at Forest Home Rd lot 72B
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
undeveloped
Residential, undeveloped, etc.
6. Property Size 0.750
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Place rip rap along approx 250' of shoreline to aid in erosion control
8. How will the work be done?* From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
1000 sq ft.
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
750 sq ft
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet landward to
be impacted: *
(number of trees, for instance)
Only trees 2" or less, undermined or dead will be removed
Sketch: stamperdrawings.pdf 476.83KB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Kim Broome

Signature:
Submittal Date: 1/3/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220034 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Doug Perez:eads\djperez
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

Agent Authorization Form
PROPERTY LEGAL DESCRIPTION -
LOT NO.' �A� PLAN NO.
PARCELD: AA--AIS
STREET ADDRESS : ?`� CA
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached_
Property Owner's Address (if differentthan property above):
Telephone: _\,�- -
We hereby certify the above information submitted in this application is true and accurate to the
bestof our knowledge_
Authorized Signature Authorized Signature
Date: r�� �C�_ ....__ Date: \—'3 as

'PS

can submit an application.
Signature"
Submittal Date 11/24/2021

Contact Name* Kim Broome
Contact Email Address'
[e-mail]
Project Owner*
Robert Stamper
Project Name*
Stamper Shoreline
Project County*
Mecklenburg
Owner Address: *
Street Address
13000-F South Tryon St.
Address Line 2
City
Charlotte
Postal ! Zip Code
28278
Is this a transportation project? *
Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - 401 Water Quality Certification -
-Regular Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?
Yes No
State ! Province / Region
North Carolina
Country
United States
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.
Place approx 250' of rip rap to shoreline to aid in erosion control.
Location of rip rap will be at Forest Home Rd, Charlotte, NC Parcel
number 217-232-51. Lot has no house or dock on property. No
address has been assigned.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401
Certification Rule.
. I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting
location and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you

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FORM: SSGP 09-2020 Page 4 of 6

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FORM. SSGP 09-2020 Page 5 of 6